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The paper presents the diagnostic features of 95 cases with complicated forms of abdominal tuberculosis (AT). The latter has been found to be concurrent with disseminated progressive pulmonary tuberculosis in 97.3% of cases. HIV infection is present in 25.2% of the patients. In 42.1%, a complication of AT is its first onset. The late diagnosis of AT in the phase of development of complications is due to its asymptomatic course at the early stage, the similarity of clinical manifestations with various nonspecific abdominal diseases, the low informative value of radiodiagnostic techniques, and scanty bacterial excretion. In this connection, AT is detectable in 92.6% with the development of acute surgical abdominal pathology requiring emergency diagnostic laparoscopy and surgery. Among all acute surgical abdominal diseases, complicated abdominal tuberculosis ranks third, which in the presence of any abdominal symptoms, particularly those concurrent with pulmonary tuberculosis needs examination for abdominal tuberculosis. Various surgical interventions (more commonly right-sided hemicolectomy, enterectomy, and abdominal abscess lancing) were made in 92 patients with complicated abdominal tuberculosis. There were intraoperative complications, such as perforated tuberculous intestinal ulcers (54.7%), ileus (30.5), abdominal and retroperitoneal abscesses (11.6%), as well as other rare complications, such as intestinal hemorrhage, perforated tuberculous gastric ulcer, and splenic abscess (3.2%). In 42.1% of cases, surgery was ineffective and it was followed by the development of recurrent complications that required surgery. In HIV-infected patients, AT ran more severely. Overall mortality in patients with AT was 47.4%, that in patients with and without HIV infection was 58.3 and 43.7%, respectively.

A hundred and thirteen case histories of patients with isolated and generalized forms of abdominal tuberculosis were analyzed. The patients' age was 15 to 79 years; there were 86 (76.1%) males and 27 (23.9%) females. The patients were admitted more frequently from other tuberculosis facilities (66.7%) and less frequently from general hospitals (33.3%). In 62 (54.9%) cases, abdominal tuberculosis showed a complicated course. The residents of Moscow and its region, predominantly the unemployed (85.8%), prevailed in the structure of detected patients with abdominal tuberculosis. In the period of 2001 to 2004, there was a rise in the incidence of new-onset abdominal tuberculosis, its rate increased from 4.4 (2001) to 8.3% (2004) of the total number of patients admitted to Moscow clinical hospital No. 7 for extrapulmonary tuberculosis admitted. This gives no way of considering this site of tuberculosis to be rare. In the structure of abdominal tuberculosis, its generalized forms were prevalent (86.7%), which was associated with the late detection of abdominal tuberculosis and the significant increase in the number of HIV-infected patients from 14.3 (2000) to 33.3% (2004). Abdominal organ lesions were more frequently observed in severe generalized pulmonary processes, such as disseminated (45.1%), infiltrative (18.6%) or fibrocavernous (15.9%) tuberculosis. An algorithm of diagnosis of abdominal tuberculosis and the rates of its detection by various studies are presented in the paper. Abdominal tuberculosis was diagnosed in 8.9% of cases by noninvasive comprehensive examination methods, in 18.6% by laparoscopy, and in most cases (57.5%) intraoperatively. In socially dysadapted persons, postmortem abdominal tuberculosis was detected in 15% of cases.

M. avium and three M. tuberculosis strains were used as an example to study the bacteriostatic activity of the liposomal form of isoniazid in the liquid nutrient medium by serial dilutions. Unlike isoniazid in solution, its liposomal form was found to suppress the multi plication of all study mycobacterial samples and diminishes their viability, but at different concentrations. The liposomes that did not contain the drug exerted an inhibitory effect only on the M. tuberculosis strains H37Rv and Erdman. It is suggested that the change in isoniazid sensitivity results from the effect of liposomal phospholipids on some mycobacterial enzymes. Electron microscopy indicated that the liposomal form of isoniazid is able to penetrate into the alveolar macrophageal cytoplasm of guinea pigs just 30 min after incubation.

The present study has explored the specific features of the detection, clinical manifestations, and treatment of tuberculosis (TB) in 425 patients with TB and HIV infection. According to the time of joining the infections, the patients with TB and HIV infection are divided into 2 basic groups: 1) HIV infection is primary, TB develops at any stage of HIV infection and 2) TB is primary, HIV injections joins different forms of TB at its any stage. The social makeup of patients with TB/HIV infection is unfavorable: the unemployed, 50%; homeless persons, 26.5%; employees, 5%; workers, 9%; pensioners, 1.5%; the disabled, 5%; pupils, 3%. As compared with Group 2, Group 1 shows more employees and pupils and fewer homeless persons, which is associated with the younger age of patients in this group and their greater social security. In the pattern of clinical forms of tuberculosis in Group 1, there are prevalent forms of primary tuberculosis with lesion of intrathoracic and peripheral lymph nodes (12.8%), acutely progressive disseminated and miliary tuberculosis of the lung and extrapulmonary systems and organs (49%), among them, meningitis accounts for 4%, lesions of the liver, spleen, kidney, and other organs form 17%. In patients with tuberculosis and HIV infection, bacterial isolation has been established in 58% of cases; primary and multidrug resistances have been found in 53 and 8.9%, respectively. Multidrug resistance tends to increase: 2% in 2001, 3.4% in 2002, 4.6% in 2003, and 8.9% in 2004. Bacteria have been more frequently isolated in Group 2 than in Group 1 (81% vs 19%), which is accounted for by the magnitude of destructive changes in them in the presence of infiltrative TB and by the high incidence of fibrocavernous tuberculosis. The patients with TB/HIV infection have a concomitance of 3 infectious diseases: HIV infection, TB, and, in 74% of the patients, sexually transmitted infections (syphilis, chlamydiosis, gonorrhea) that, in accordance with Resolution No. 188 passed by the Government on April 2, 2003, are in the list of infectious diseases constitute a serious hazard to other people. The proportion of TB/HIV patients with drug abuse (65%), hepatitis B and C (47%), and nervous and mental diseases is extremely high, which makes these patients more hazardous to the healthy population. The efficiency of treatment for TB and HIV infection is satisfactory. Continuous therapy for 4 months or more provides positive clinical and X-ray changes in most patients; bacterial isolation ceases in 75%, and decay cavities close in 44% of cases. Abacillation and cavity closures have been observed in 76.3 and 38% and 47 and 14% of cases in Groups 1 and 2, respectively. Six-eight-month therapy with first-line drugs in combination with reserve ones in patients with pulmonary TB and HIV infection is well tolerated and highly effective. A decision on the duration of anti-TB treatment for the HIV infected should be taken into account the program resources and the probability of refusing long-term therapy in 50% of cases. Mortality rates in patients with TB and HIV infection are gradually on the rise and equal to 11.2% of the treated patients in 2001, 5% in 2002, 15.2% in 2003, and 19.6% in 2004. In patients with HIV/TB, the rates are higher than those in patients with TB/HIV and are 19.2 and 14.5%, respectively. Acutely progressive pulmonary TB and miliary TB of the lung and extrapulmonary organs and systems are a cause of death in most (76%) patients with TB/HIV.

Data on 1112 tuberculosis patients with various neurological complications who were treated at Moscow Tuberculosis Clinical Hospital No. 7 during 1997-1999 are analyzed. A working classification of neurological complications in tuberculosis, which may be recommended to therapeutists, phthisiologists, and neurologists, is proposed. The leading neurological complications in nonspecific tuberculosis are described. The acute toxic encephalopathy syndrome that is characterized by a combination of impaired consciousness, meningeal syndrome without spinal fluid changes, epileptic seizures, disseminated neurological symptoms, disseminated intravascular coagulation syndrome, and high death rates holds the lead. Mono- and polyneuropathies of predominantly the lower extremities are frequently detectable in tuberculosis. Concomitant alcoholism, diabetes mellitus, and isoniazid treatment make their course poorer. Vascular abnormalities of the nervous system in patients with tuberculosis run much more favourably that in those without it. Mild forms of parkinsonism were observed in 3% of patients with tuberculosis, vascular dementia is detectable rarely (0.2%), strokes run without severe overall cerebral symptoms. The high incidence of neurological diseases in patients with tuberculosis requires that specialized departments of neurology should be set up at the institutes of tuberculosis and at multidisciplinary related hospitals. The tuberculosis curricula for students and postgraduate physicians should envisage additional sections to study diseases of the nervous system in tuberculosis.

The outcomes of treatment of 110 homeless patients with tuberculosis admitted to Moscow City Clinical Hospital No. 7 in 1993-1996 were followed up. All homeless persons have various concurrent diseases, such as alcoholism, chronic nonspecific diseases of the lung, diseases of the cardiovascular system, kidney, liver, etc., which require their treatment by physicians of different disciplines. Good results of treating the homeless may be obtained when rehabilitative services are used and hospital treatment is performed for at least 4 months. All homeless patients who admitted to general hospitals are to be physically, roentgenologically, and bacterioscopically examined whether they have tuberculosis.

133 homeless subjects with pulmonary tuberculosis were examined microbiologically in Moscow Tuberculosis Hospital N 7 in 1993-1994. In most of the examinees the disease was advanced with destruction and intensive bacterial discharge (100-10,000 microbes in the sample). New-onset cases discharged mycobacteria with multiple drug resistance. Acquired drug resistance was registered in 83.8% of previously treated patients, 73% of them had resistance to 2-6 drugs. Isoniazid-, rifampicin- and streptomycin- resistant were 48.6, 33.8 and 63.5% of the examinees, respectively.

Dipeptide carnosine effect on fibroblast proliferation was assessed by changes in intracellular pH (pHi) in human cultivated lung embryonal fibroblasts. pHi was defined by means of fluorescein diacetate (FDA) during 1-7 days of the culture growth. The investigation showed changes in pHi depending on dipeptide concentration and the presence of additives in it. In some cases rat carnosine caused acidification of cells assumed to be a reaction and the presence of additives of metals in the drug. Sometimes an increase in pHi was observed immediately or shortly after acidification of the cells. In this case dipeptide was assumed to have a stimulating influence on fibroblast pHi due to a low concentration of additives in the drug and fast adaptation of cells. Purified carnosine increased pHi immediately after its addition to the incubation medium. The maximum effect was observed after addition of 10 mkg/ml carnosine, delta of pHi was on the average of 0.22. An increase of carnosine concentration to 50-100 micrograms/ml did not lead to increased effect. So, the increase of fibroblast pHi upon introduction of carnosine may be one of the causes of activation of fibroblast proliferation. The pH-metry method may be recommended as an express-test for the evaluation of the degree of a drug purification.

The authors studied changes in beta- and alpha 1-adrenoceptors (beta-AC, alpha 1-AC) as well as in m-cholinoceptors in tuberculosis, pneumonia and cancer. Specimens of the lung parenchyma were obtained at thoracic surgery from 43 patients. Relevant ligands binding to the receptors was evaluated by incubation of the membrane proteins with radioligands varying in concentrations. Irrespective of the inflammation variant, beta-AC and alpha 1-AC levels were found decreased this being an correlation with the scope of fibrous and destructive involvement. The degree of the process chronicity and advance was judged from a decline in the binding parameters for beta-AC and alpha 1 AC. A dramatic fall in alpha 1 AC occurred in tuberculosis. This may be related to microcirculatory failure and vascular deformity. The levels of m-cholinoceptors underwent insignificant changes in pulmonary inflammation, whereas lung cancer displayed their sharp rise.

Adrenergic receptors were studied in human lung parenchyma obtained from 10 patients with tuberculoma after segmental resection within the limits of surrounding normal tissues (controls) as well as from 10 patients with destructive pulmonary tuberculosis. Binding of alpha-adrenergic radioligand 3H-prazosin was saturable with high rate of affinity in lung parenchymal membranes of both normal tissues and tissues impaired with tuberculosis. The Scatchard analysis indicated that the affinity of 3H-prazosin binding was not altered in patients with tuberculosis, while amount of the ligand binding sites was significantly decreased as compared with control preparations (KD = 0.5 +/- 0.9 nM, Bmax = 273.5 +/- 59.9 fmol/mg in controls; KD = 0.5 +/- 0.07 nM, Bmax = 51.7 +/- 7.5 fmol/mg in tuberculous lung parenchyma). beta-Adrenergic and muscarinic acetylcholinergic receptors were studied in lung parenchyma of patients with tuberculosis. Binding parameters of beta-adrenergic ligand 3H-dihydroalprenolol and muscarinic antagonist 3H-quinuclidinyl benzylate were similar to those of control values. Amount of 3H-dihydroalprenolol binding sites was not markedly altered while content of 3H-prazosin binding sites was considerably decreased in lung parenchyma of patients with tuberculosis as compared with normal state. The data obtained suggest that population of alpha-adrenergic receptors was decreased in human lung parenchyma under conditions of destructive tuberculosis.

beta-Adrenergic and muscarinic cholinergic receptors have been investigated in human lung parenchyma during cancer and chronic pneumonia as compared with normal tissue, obtained after segmental resection of tuberculoma from surrounding normal tissues. Binding of beta-adrenergic radioligand 3H-dihydroalprenolol (3H-DHA) and muscarinic antagonist 3H-quinuclidinyl benzylate (3H-QNB) was saturating with high rate of affinity in lung parenchyma membranes of both controls and patients with cancer and chronic pneumonia. Amount of binding sites of 3H-QNB was significantly increased in cancer (Bmax = 377.5 +/- 65.5 fmole/mg) and did not change in chronic pneumonia (Bmax = 97.7 +/- 14.7 fmole/mg) as compared with normal tissues (Bmax = 108.9 +/- 12.1 fmole/mg); a number of binding sites of 3H-DHA was significantly decreased both in lung parenchyma under conditions of cancer (Bmax = 84.1 +/- 14.5 fmole/mg) and chronic pneumonia (Bmax = 113.8 +/- 10.3 fmole/mg) as compared with normal tissue (Bmax = 456.7 +/- 73.7 fmole/mg). The affinity of 3H-DHA and 3H-QNB binding was practically unaltered. The results obtained suggest the important role of beta-adrenergic receptors in formation of lung cancer in the patients with pneumonia.

beta-Adrenergic and muscarine acetylcholinergic receptors were studied in human lung parenchyma obtained from patients with tuberculoma (after segmental resection of tuberculoma surrounding normal tissues were performed to obtain control samples) as well as from patients with pulmonary adenocarcinoma. Assays of binding of beta-adrenergic radioligand 3H-dihydroalprenolol (3H-DHA) exhibited high affinity in lung parenchyma membranes in both control samples and in that of patients with tumors. Binding of muscarine antagonist 3H-quinuclidinyl benzylate (3H-QNB) also showed high rate of affinity in lung parenchyma. High number of 3H-DHA binding sites was distinctly decreased and 3H-QNB--was increased in lung malignant tumors as compared with normal tissue. Considerable decrease of beta-adrenergic and increase of muscarine receptors were found in patients with pulmonary adenocarcinoma. beta-Adrenergic and muscarine receptors appear to be of importance in pathogenesis of human lung malignant tumors.

Repair processes in the bronchus stump after pneumonectomy in 25 rats and 25 guinea-pigs were analysed. The tests were conducted on 1, 3, 7, 14 and 30 days of the postoperative period using bronchus stump and its bottom material for semithin ++ slices and electron microscopy, respectively. At early stages, besides necrotic and necrobiotic changes in the bronchus stump, compensatory and adaptive reactions are also observed. 14 days after operation there was a restoration of epithelial lining and formation of granulation tissue around the stitches. By the 30-th day considerable degenerative and functional changes are detected in the lamina proper, including its cellular elements, as well as in the structure of collagenic, elastic and smooth muscular fibers. Basal cells, endotheliocytes and fibroblasts are the most active sources of regeneration.

In experiments on 150 guinea pigs, processes of lung wound healing were followed and the more active cellular sources of regeneration were identified. Measurements of cyclic adenosine monophosphate components in the course of lung healing indicated that histologic and electron-microscopic studies would be more informative if done at days 1, 3, 4, 7, and 14 after lung damage. Both cellular and intracellular mechanisms of regeneration were involved in the healing processes. The type II pneumonocyte be designated as a cambial cell of pulmonary parenchyma, for this cell displays the highest proliferative potency and is responsible for the epithelial lining of newly formed alveoli. The formation of these is shown to be assured through functional activity of all cellular alveolar elements (involving intracellular hyperplasia and hypertrophy of ultrastructures and especially dynamic morphological and functional alterations in osmiophilic bodies of type II pneumonocytes) and capillary neoformation.

The influence of carnosine (beta-alanine, alpha-histidine) on the process of lung wound reparation was studied in 90 guinea-pigs. Its efficacy was evaluated microscopically, histologically and by means of electronic microscope. It was established that carnosine, as compared to controls nearly twice accelerates reparative processes in the injured lung by activation of fibroblast proliferation, connective tissue generation and intracellular regeneration. In type II epithelial cells more intensive formation of osmiophilic bodies and lamellar bodies contained in them is observed. The alveolus formation in the wound lips by the 7-8th day after lung injury is going on under the carnosine influence, which is due, probably, to massive excretion of osmiophilic contents from type II epithelial cells and surfactant production. This may be connected with rapid decrease of atelectasis and rapid restoration of lung airness within the wound.